title: Acute myocardial infarction rehospitalization of the medicare fee-for-service patient: a state-level analysis exploring 30-day readmission factors.
abstract: OBJECTIVE
  Acute myocardial infarction (AMI) readmission among the older adults is frequent and costly to the Medicare Trust Fund and to the patient in preventable suffering. In this study, we explore factors that are associated with states having AMI readmission rates that are higher than the U.S. national rate.
  
  
  METHODS
  Acute inpatient hospital settings.
  
  
  METHODS
  Multivariate regression analysis of 50 state-level data is used. The dependent variable AMI 30-day readmission worse than U.S. rate is based on adult Medicare fee-for-service patients hospitalized with a primary discharge diagnosis of AMI and for which a subsequent all-cause readmission occurred within 30 days of their last discharge.
  
  
  RESULTS
  We find one key variable--states with more β-blocker prescription given at discharge--that is significantly associated with a decrease in probability in states ranking "worse" on AMI 30-day readmission. Whereas, states with more total days of care per 1,000 Medicare enrollees, more community hospital outpatient visits per 1,000 population, and greater aspirin prescription given at discharge have a greater probability for AMI 30-day readmission to be "worse" than the U.S. national rate.
  
  
  CONCLUSIONS
  Case management programs targeting efficient medication reconciliation from the hospital setting to the transfer setting can potentially help minimize readmission for patients highly dependent on β-blockers for improved clinical outcomes. This intervention may be more effective than other factors to improve state-level hospital status on AMI 30-day readmission. Factors such as total days of care per 1,000 Medicare enrollees, more community hospital outpatient visits per 1,000 populations, and greater aspirin prescription given at discharge may not be as important as β-blocker prescription given at discharge.
authors.affiliation: Mary Schmeida, PhD, is an expert in public health policy who has served in several key research positions and is also affiliated with Kent State University. Her research in health care and welfare policy has been published and presented nationally and internationally. Ronald Savrin, MD, MBA, is an internationally recognized Vascular Surgeon who has served as Professor of surgery and has held numerous administrative, educational, and corporate appointments. He has led state and national quality improvement programs and is actively engaged in nationwide efforts to improve the medical care delivery system.
authors.forename: Mary
authors.initials: M
authors.lastname: Schmeida
authors.forename: Ronald
authors.initials: R
authors.lastname: Savrin
mesh_terms: D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000628:therapy*; D010359:Patient Readmission; D012044:Regression Analysis; D014481:United States